2018 MIDTERM ELECTION

NOTE: The good news is that I don't have to worry about any sabotage impact for Massachusetts in 2019 (thanks to the state still having their pre-ACA individual mandate penalty in place and banning #ShortAssPlans outright). This obviously makes that part of my analysis very easy--I can just enter "0%" across the board in the "2018 sabotage factor" columns.

The bad news is that determining the market share for each carrier in Massachusetts is a royal pain in the ass. only two of the twelve carriers offering individual market plans actually state what their enrollment numbers are, and this is further confused by the fact that several of them (Fallon, Harvard Pilgrim and Tufts) have two or three different listings for different divisions of the company.

In addition, Massachusetts is one of just two states where the individual and small group market risk pools are merged, making it even more difficult to separate out the two for market share purposes.

I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system. The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.

This post was inspired by a Twitter query by "Other Alex". He originally asked about the insanely expensive premiums for ACA policies in Charlottesville, Virginia, which I wrote about the other day. Anyway, after some back & forth between him, myself and Colin Baillio, Alex asked if I knew where the least-expensive ACA plans are.

I haven't looked it up by rating area yet (for instance, Virginia as a whole ranks 18th most expensive this year even though Charlottesville is the most expensive rating area in the country), but on a state-level basis, it appears that the least expensive state for ACA-compliant individual healthcare policies is actually...(drumroll please)...

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

I've confirmed with the Massachusetts Health Connector that their official QHP selection tally stood at exactly 262,534 as of Christmas Day (12/25).

This puts them a mere 232 higher than they were 6 days earlier (12/19), which seemed a little odd to me given that 12/23 was MA's deadline for January 1st coverage; normally I'd expect a last-minute enrollment surge in the final days ahead of a big deadline, although it's not nearly as big a deal in the states which still have later deadlines for February or March coverage. On the other hand, Christmas Eve and Day were included here, and no one enrolls in health insurance on Christmas, of course. I wouldn't expect much this week either with New Year's coming up; there's usualy a 9-day Dead Zone from 12/24 - 1/01 anyway.

Their record to date was last year, when they had a total of 266,664 QHP selections through January 31st, 2017...and unlike most states, the deadline in MA is still a month away (residents have until 12/23 to enroll for January coverage and until 1/23/18 to enroll for February coverage).

This gives Massachusetts a full 5 weeks to add at least 4,400 more people to break that record. They've added 2,487 in the past 13 days; if they kept that pace they'd add 6,685 more between now and 1/23, so it's not unreasonable to think they can pull that off.

Anyway, the CMS Public Use File lists Massachusetts as officially enrolling 247,121 people as of December 10th last year, so they're still running 5.3% ahead of that. They need 6,300 more enrollees (net) to break last year's record...but keep in mind that MA is one of the states with an extended deadline: Baystaters can still enroll as late as January 23rd.

Excellent news out of Massachusetts! I haven't posted any updates from the Bay State since 11/15, when they reported enrollments were up 40% year over year, but today they've given me very comprehensive and up-to-date numbers:

As of Dec. 6, we had a total of 259,815 plan selections and enrollments. This includes auto renewal of existing members. Of that, 26,074 are people who are new for 2018.

For comparison sake, for Dec. 6, 2016, we were at 244,845, and 25,746 for the new. These numbers also includes auto renewal, of course.

Obviously when you throw auto-renewals into the mix, the percentage increase drops substantially, but they're still up 6% over last year (nearly 15,000 people), and new enrolles are up about 1%.

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

Unlike most states, the Massachuetts exchange also handles premium billing/payments themselves, so they have a more elaborate enrollment reporting system. However, I've confirmed the following breakout:

*"Returning enrollees" means someone who's already in the MA exchange system because they were previously enrolled in an exchange policy in the past but isn't currently enrolled in one. For instance, they might have been enrolled from 2015-2016, but then left the exchange for 2017 and is returning for 2018.

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

Massachusetts has one of the stablest statewide insurance markets, no doubt in large part due to their having instituted the precursor to the ACA, "RomneyCare", 4 years earlier. Massachusetts also merged their small business and individual market risk pools, which helps stabilize things. As a result, they have a high number of carriers participating in their ACA exchange and are among the few states with single-digit average rate hikes...assuming CSR payments are forthcoming and the individual mandate is properly enforced.

Assuming CSR payments aren't made, I used the Kaiser Family Foundation's 19% average estimate for Silver plan hikes due to the CSR factor. Since a whopping 92% of MA's exchange enrollees chose Silver plans (it looks like MA's unique "ConnectorCare" plans are considered Silver as well), that means an average CSR factor of around 17.5 points across the entire individual market.

Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.